Inhaler technique in Turkish people with poor English: a case of ...

112 Pharm World Sci (2006) 28:107–114
Table 5 Comparison of
key steps in technique in
fluent English-speakers
and Turkish-speakers
with poor English
Shakes inhaler
(% correct)
suggests that GP perception of clinical need was
similar in the two groups.
The majority of participants in both FE and EP
groups said they remembered a demonstration of
how to use their inhaler when it was first prescribed.
In addition, they would all have received
the manufacturer’s PIL, which is included in
every inhaler pack. These mandatory leaflets,
defined by EU regulations, act as a reference
source for the patient and family and carers and
are intended to complement and reinforce any
verbal advice from health professionals. PILs for
asthma inhalers provide illustrations of the key
steps in correct use, but these need to be viewed
in conjunction with the text to be fully understood.
It is therefore, reasonable to propose that the
inability to read and understand the written
information on how to use their inhaler may have
made it more difficult for the EP group to develop
good inhaler technique. Cultural differences in
the use of primary care preventive services would
have perpetuated this information deficit. Our EP
sample was hard to recruit through surgeries, and
also much less likely than the FE group to use
non-acute services such as nurse-run asthma
clinics. There were therefore, fewer opportunities
for nurses and GPs to pick up and correct misunderstandings
about technique.
Table 6 Global technique change after intervention in
poor English-speakers
n shakes
(sd)
Checks
mouthpiece
(% correct)
Co-ordination
(% correct)
Breathing-in
time(secs)
Fluent English 59(59%) 4.7 (5.9) 4 (4%) 28 (29.5%) 7.8 (4.4)
n = 100 n =99 n = 100 n =95 n =52
Poor English 38 (55%) 7.0 (4.1) 10 (14.5%) 8 (11.6%) 4.8 (6.3)
n =69 n =40 n =69 n =69 n =52
Difference ns P < 0.05 P < 0.01 P < 0.02 ns
MTS PIL + translator
After
PIL
After
PIL + verbal
Worse than baseline 5 (15%) 5 (16%) 4 (11%)
No change 12 (35%) 18 (56%) 16 (48%)
Better than baseline 17 (50%) 9 (28%) 15 (45%)
123
Poor reading skills are not just a problem for
people whose first language is not English.
Nationally 4 in 10 adults have been estimated[13]
to have difficulties in coping with everyday literacy
and numeracy requirements. A recent survey
[14] found that 15% of 127 consecutive patients
(125 Caucasian) attending a rheumatoid arthritis
clinic were functionally illiterate. These patients
did not have more severe disease than patients
who could read information about their condition,
but were more anxious and visited hospital
more often.
Motivation to read and the perceived authority
of the information source are also factors. All of
our volunteers with FE were able to read, yet a
proportion also had poor technique. FE asthmatics[15]
do not always look at PILs, or see
them as important. They place a higher value on
face-to-face individualised advice.
Properly blinded studies of interventions to
improve inhaler technique have rarely been
attempted. The present study has attempted to
overcome the problem of bias by filming patients
using their inhalers and then digitising the films
for ‘‘blind’’ assessment. Deciding if chest movement
had occurred was sometimes very difficult,
and this may explain the relatively low level of
agreement between assessors.
Bearing this weakness in mind, brief exposure
to own-language information presented via multimedia
and a translated leaflet with translator
support appeared to be equally effective in
changing what some inhaler users did, at least in
the short term.
Approximately, half the subjects had improved
their technique after information given by either
method. The effect of written translated information
alone was smaller; only one quarter of
subjects improved after a leaflet.